AASLD
- All patients receiving care in primary care and GI or hepatology outpatient clinics, emergency departments, and inpatient admissions should be routinely screened for alcohol use using validated questionnaires.
- Brief intervention, pharmacotherapy, and referral to treatment should be offered to patients engaged in hazardous drinking (AUDIT-C ≥4, AUDIT >8, binge drinkers).
- Alcohol biomarkers can be used to aid in diagnosis and support recovery. Urine and hair ethyl glucuronide, urine ethyl sulfate and Peth are not affected by liver disease, and therefore preferable.
- Referral to AUD treatment professionals is recommended for patients with advanced ALD and/or AUD in order to ensure access to the full range of AUD treatment options.
- Multidisciplinary, integrated management of ALD and AUD is recommended and improves rates of alcohol abstinence amongst ALD patients.
- Based on limited data, the use of acamprosate or baclofen can be considered for the treatment of AUD in patients with ALD.
- Lab-based prognostic scores should be used to determine prognosis in alcoholic hepatitis.
- The Maddrey Discriminant Function (≥32) should be used to assess the need for treatment with corticosteroids or other medical therapies.
- A MELD score of >20 should prompt consideration of steroid treatment.
- Abstinence from alcohol should be promoted to improve long-term prognosis in AH.
- Prednisolone 40 mg/day given orally should be considered to improve 28-day mortality in patients with severe AH (MDF ≥32), without contraindications to the use of Steroids
- The addition of IV NAC to prednisolone 40 mg/day may improve the 30-day survival of patients with severe AH.
- The Lille score should be used to reassess prognosis, identify non-responders and guide treatment course after 7 days of corticosteroids.
- Patients with AH should have malnutrition addressed and treated, preferably with enteral nutrition.
- Abstinence is key to long-term survival;
- Pentoxifylline is no longer recommended in the treatment of AH.
- Liver transplantation may be considered in carefully selected patients with favorable psychosocial profiles in severe AH not responding to medical therapy.